The Health Law Firm Blog

DECEMBER 31, 2022

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D.,

Licensing 52

Licensing Nurses Fraud Medicaid 52

Provider Trust

APRIL 26, 2023

However, this solution comes with its share of compliance risks, especially if interstate licenses are involved. Nurse Strikes and Interim Solutions Present Licensure Challenges In 2021 and 2022, hospitals like Mount Sinai in New York and St. It’s no wonder nurse strikes have been on the rise.

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Licensing Nurses Compliance COVID-19 52

The Health Law Firm Blog

DECEMBER 16, 2022

Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D.,

Licensing 52

Licensing Nurses Fraud Medicaid 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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Fraud Medicaid Medicaid Nurses 52

Provider Trust

MARCH 13, 2023

Between 2016 and 2021, over 7,600 fake diplomas were sold to nursing students who used the fraudulent degrees to qualify for the National Council Licensure Exam (NCLEX). State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment.

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Fraud US Department of Health and Human Services Licensing Compliance Officers 52

The Health Law Firm

FEBRUARY 14, 2022

Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. By George F. Indest III, J.D.,

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Medicare Medicare Fraud Doctors 52

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors?

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

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Nurses Licensing Fraud Medicaid 52

HIPAA Journal

MARCH 25, 2022

The forensic investigation revealed the email accounts were accessed by unauthorized individuals between April 7, 2021, and June 2, 2021. AHA provided notice about the attack on January 6, 2021. UMC was a victim of a REvil ransomware attack in June 2021 that resulted in the theft of the protected health information of 1.3

Health Insurance 119

Health Insurance Licensing Ransomware Fraud 119

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

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Fraud Health Insurance Ransomware HIPAA 111

Healthcare Compliance Blog

MARCH 10, 2022

Complaints of resident abuse in a Michigan nursing home led to an investigation by the Michigan Office of Attorney General’s Health Care Fraud Division, working with the Michigan Sentinel Project. The investigation determined that a nurse was working at the nursing home while her license was suspended, which is a felony.

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Nursing Homes Nurses Licensing Fraud 59

HIPAA Journal

FEBRUARY 14, 2023

Hackers gained access to Umass Memorial Health’s email environment between June 24, 2020 and January 7, 2021, as a result of responses to phishing emails. Claims may also be submitted for extraordinary losses up to a maximum of $5,000, which can include documented, unreimbursed losses to fraud and identity theft.

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Fraud Licensing Health Insurance HIPAA 104

HIPAA Journal

DECEMBER 19, 2022

A review of the files on the compromised servers confirmed that protected health information such as patient names, dates of birth, Social Security numbers, driver’s license numbers, health insurance information, and diagnosis and treatment information had been exposed. The DOL and the U.S.

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Fraud Licensing HIPAA Health Insurance 105

HIPAA Journal

FEBRUARY 15, 2023

The medical device manufacturer Electromed has proposed a $850,000 settlement to resolve claims related to a June 2021 ransomware attack and data breach involving the protected health information of 47,200 individuals.

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Ransomware Fraud Licensing Health Insurance 97

HIPAA Journal

FEBRUARY 16, 2023

The Nashville, TN-based health system, Advent Health Partners, has proposed a $500,000 settlement to resolve claims related to a September 2021 data breach involving the protected health information of 61,072 patients. Advent Health Partners detected a breach of its email environment in early September 2021.

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HIPAA Fraud Licensing Health Insurance 104

Med-Net Compliance

SEPTEMBER 14, 2022

A Massachusetts home health aide, who was licensed as a Certified Nursing Assistant (CNA), has been indicted in connection with a home surveillance video showing her abusing an elderly patient, Attorney General Maura Healey announced. The aide was indicted by a grand jury on two charges of assault and battery on an elder by a caretaker.

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US Department of Health and Human Services Fraud Medicaid Medicaid 59

HIPAA Journal

NOVEMBER 16, 2022

Suspicious activity was detected within its email environment on December 16, 2021, passwords were changed to prevent further unauthorized access, and third-party cybersecurity experts were engaged to investigate the unauthorized activity. Notification letters were sent to affected individuals on October 31, 2022.

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HIPAA Licensing Health Insurance Fraud 98

HIPAA Journal

SEPTEMBER 12, 2023

Seymour, IN-based Schneck Medical Center has settled a lawsuit with the Indiana attorney general, Todd Rokita, over a 2021 ransomware attack and data breach that affected 89,707 Indiana residents.

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HIPAA Ransomware Health Insurance Fraud 98

HIPAA Journal

SEPTEMBER 8, 2022

The Michigan law firm, Warner Norcross and Judd LLP, has issued notification letters to 255,160 individuals advising them about an October 2021 security breach in which files containing their personal and protected health information were potentially accessed and exfiltrated from its systems. The breach was detected on October 22, 2021.

Fraud 79

Fraud Health Insurance Ransomware HIPAA 79

The Health Law Firm Blog

MAY 12, 2023

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By George F. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her [.]

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

HIPAA Journal

APRIL 1, 2022

On January 24, 2022, SRHD announced that an employee email account had been compromised on December 21, 2021. Between June 24, 2021, and July 2, 2021, emails and attachments in a Ciox Health employee’s email account were downloaded by an unauthorized individual.

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Fraud HIPAA Licensing Health Insurance 137

HIPAA Journal

APRIL 15, 2022

A subset of individuals also had their Social Security numbers and/or driver’s license numbers exposed. SuperCare Health said unauthorized individuals had access to its network between July 23, 2021, to July 27, 2021, but did not disclose the nature of the cyberattack.

Electronic Medical Records 125

Electronic Medical Records HIPAA Health Insurance Fraud 125

Med-Net Compliance

SEPTEMBER 7, 2022

A 49-year-old Texas physician assistant was arrested and charged for his role in a scheme to defraud Medicaid by working with a suspended medical license. On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of his physician assistant license, deeming him to be a “continuing threat to public welfare.”

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Medicaid Medicaid Licensing Medical Personnel 59

The Health Law Firm Blog

FEBRUARY 15, 2022

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. By George F. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her.

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Medicaid Medicaid Fraud Licensing 52

HIPAA Journal

DECEMBER 7, 2022

Urology of Greater Atlanta Notifies Almost 80,000 Patients About August 2021 Data Breach. Urology of Greater Atlanta has now confirmed that it was the victim of a cyberattack that was detected on August 29, 2021. In some cases, Social Security numbers, driver’s license numbers, or financial account information, were also exposed.

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COVID-19 Vaccine COVID-19 Department of Veterans Affairs Licensing 95

Innovaare Compliance

FEBRUARY 9, 2021

New CMS star ratings criteria 2021. With the CMS release of the Final Rule for Contract Year 2021 on May 22, 2020, Medicare Advantage (MA) plans now have some near-term clarity regarding the many star-rating proposals made earlier this year. Read More – Medicare Star Ratings Changes 2021 . Industry trends. CMS Newsroom.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

DECEMBER 10, 2021

Fraud Schemes in a Telehealth Era: What Healthcare Payers Should Know. What You Should Know: – Report from Codoxo that finds 10-15% of telehealth claims fall outside of approved CMS codes and indicates a high potential for rapidly increasing fraud schemes (and provider coding errors) in a new telehealth era. Report Background.

COVID-19 95

COVID-19 Fraud Nurses Licensing 95

HIPAA Journal

MAY 25, 2022

SAC Health said it is unaware of any actual or attempted misuse of patient data as a result of the break-in; however, as a precaution against identity theft and fraud, affected individuals have been offered complimentary credit monitoring services. Notification letters were sent to those individuals on May 3, 2022.

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Ransomware Fraud HIPAA Licensing 134

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Licensing Governance 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Licensing Governance 52

Verisys

JUNE 8, 2023

Without technology automation, on average, it takes two to four months to complete the credentialing and enrollment for a newly hired licensed medical professional. Fraud Data Gap The U.S. trillion in 2021, making it highly susceptible to fraud. Let’s take a look at two areas where data gaps commonly occur.

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Compliance Fraud Licensing Medicare 52

HIPAA Journal

NOVEMBER 21, 2022

The Wisconsin-based dermatology practice, Forefront Dermatology, has agreed to settle a class action lawsuit filed on behalf of patients whose protected health information (PHI) was compromised in a ransomware attack in late May 2021. Forefront Dermatology has affiliated practices in 21 states and Washington D.C.

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Ransomware Fraud HIPAA Licensing 68

HIPAA Journal

JANUARY 27, 2023

The forensic investigation and document review concluded on December 28, 2022, and confirmed that the attackers had access to its network between December 31, 2021, and January 27, 2022, and may have viewed or obtained files that contained protected health information.

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Ransomware HIPAA Fraud Licensing 101

HIPAA Journal

SEPTEMBER 28, 2022

Wolfe Clinic used the myCare Integrity medical records platform, which was accessed by an unauthorized party on or around December 4, 2021, who deleted databases and system configuration files. The attack exposed the protected health information of 542,776 current and former Wolfe Clinic patients. million patients.

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Electronic Medical Records Ransomware Fraud HIPAA 79

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

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Fraud Compliance Officers Compliance Medicare 52

MedTrainer

APRIL 17, 2024

Navigating the complex landscape of state licensing laws can be time-consuming and costly for organizations. This may involve additional steps, such as biometric authentication or identity verification services, to prevent fraud and ensure patient safety. billion in 2021, will reach $5.6 billion by 2030.

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Licensing Compliance Fraud HIPAA 52